January 14, 2015

It used to be that people thought autism appeared sometime during the second year of life, usually around 18 months of age. Parents of children later diagnosed as having autism, in particular, were often sure that their babies were developing normally up until that time. But with more and more research showing that autism is linked to genetic variation, and the fact that autism tends to run in families, my gut feeling was always that autism didn’t just appear suddenly at 18 months. It must have been there all along, with the behavioral characteristics in babies and toddlers just being too subtle to detect. We just didn’t know exactly what to look for.

Well, now we do! Autism researchers such as speech-language pathologist Elizabeth Crais, Ph.D., CCC-SLP, have started to focus on children age two years and younger, all thanks to recent changes in technology, particularly the burgeoning array of video cameras in cell phones and iPads that most people own these days. This retrospective style of research uses early videotapes made by parents of their children who are later diagnosed with autism, and even their non-autistic siblings. Behaviors are observed and compared to the behaviors of typically developing children the same age.

The findings are indeed subtle, but definitely are predictive of later diagnoses of autism. By age 2, children with autism as compared with typically developing two-year-olds, show numerous social communication and interaction difficulties such as abnormal eye contact, lack of facial expression, limited shared enjoyment, and limited interest in social games such as peek-a-boo. They demonstrate poor imitation and poor peer relationships, with limited interest in other children. They have delayed speech or other speech problems, loss of acquired words, and no interest or means to share interest (e.g. giving, pointing, showing). Autistic two year olds also exhibit unusual play or attachment to objects, irregular sleep-arousal times, and unusual visual interests such as lights and fans.

But what about 18 month olds? Research has shown there to be many symptoms of autism present in 18 month olds when compared to typically developing peers. Specifically, joint attention (i.e. shared focus on an object) tends to be decreased, along with failure to share interest with others, little to no pointing to show objects or events, and lack of sharing joy, except in tickle and roughhousing games. As well, these toddlers do not develop simple pretend play, respond to their names and exhibit repetitive movements or postures.

Researchers have also studied infants at 9 to 12 months, and the findings are consistent. Autistic babies as compared to typically developing babies, do not respond to their names, use limited gestures, and exhibit poor eye contact, limited emotions, lack of a social smile and poor imitation. There are also sensory differences such as more mouthing of toys, social touch aversions, difficulty changing focus, extreme passivity, and extreme distress reactions. I have witnessed these very behaviors in an infant. Several years ago I was part of an amazing multidisciplinary team treating a young school-age client with Autism Spectrum Disorder. He had a baby sister, whom the team was very worried about. She just seemed different, very quiet, showing poor eye contact, limited interest and a general lack of joy. Eventually, she received the diagnosis of autism that the team had suspected all along.

Perhaps with this new information, the age at which children are given an autism diagnosis will decrease. Currently, the average age that children are diagnosed with autism in the United States is around 48 months or 4 years, and it is 5 years in Colorado! Why does the age of diagnosis matter so much? Because early intervention can make a huge difference in these children’s social-communication and play skills!

If you are concerned about your child’s behavior, interests, interaction, and social communication skills, there are some free resources available online to help you. The first is the M-CHAT-R or Modified Checklist for Autism in Toddlers- Revised with Follow-up found at https://www.mchatscreen.com/ for children age 18 to 24 months. Another very useful screening tool is the CSBS DP Infant Toddler Checklist found at http://www.brookespublishing.com/resource-center/screening-and-assessment/csbs/csbs-dp/csbs-dp-itc/ for children age 8 to 24 months of age. Many doctors will also have these screening tools available in their offices. If you suspect autism or other concerns in speech and language, please be sure to contact a speech-language pathologist, your physician or pediatrician. Early intervention can help!

Thanks for reading! Please share this post.  You never know who you may be helping!

Cindy McCallum, M.Sc., R.SLP, SLP(C), CCC-SLP

Registered Speech-Language Pathologist

Founder, WiseOwlSpeech

Source:

Crais, Elizabeth R. Identifying and Intervening with Infants, Toddlers, & Preschoolers with Autism Spectrum Disorder. Denver: Colorado Speech Language and Hearing Association (CSHA), October 2014